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endodontic Surgery  /certified fixed orthodontic courses by Indian dental academy

endodontic Surgery /certified fixed orthodontic courses by Indian dental academy



Welcome to Indian Dental Academy ...

Welcome to Indian Dental Academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.

Indian dental academy has a unique training program & curriculum that provides students with exceptional clinical skills and enabling them to return to their office with high level confidence and start treating patients

State of the art comprehensive training-Faculty of world wide repute &Very affordable.



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    endodontic Surgery  /certified fixed orthodontic courses by Indian dental academy endodontic Surgery /certified fixed orthodontic courses by Indian dental academy Presentation Transcript

    • ENDODONTIC SURGERY INDIAN DENTAL ACADEMY Leader in Continuing Dental Education www.indiandentalacademy.comwww.indiandentalacademy.com
    • A surgical approach to a failed root canaltreatment should only be considered whenan orthograde approach is not possible. The reason for failure should be carefullydiagnosed before surgery is prescribed. www.indiandentalacademy.com
    • OBJECTIVE: As in all endodontic procedures, the objective of periapical surgery is to ensure the placements of proper seal between the periodontium and the root canal foramina. When this seal cannot be achieved satisfactorily by working through the canal system (orthograde filling), a surgical procedure permits visual and manipulative control of the area and placement of the seal through the surgical site. www.indiandentalacademy.com
    • CASE 1 This tooth has been obturated with silver points, and subsequently received periradicular surgery. The correct treatment should have been orthograde retreatment and conventional obturation www.indiandentalacademy.com
    • CASE 2 This case requires complete dismantling and orthograde retreatments. Periradicular surgery is unlikely to be successful Inadequate fillings www.indiandentalacademy.com
    • INDICATIONS: Any condition a obstruction that prevents direct access to the apical third of the canal, such as: Anatomic : calcifications, curvatures, bifurcations, dens in dente & pulp stones. Iatrogenic : ridging, blockage from debris, broken instruments, old root canal fillings and cemented posts www.indiandentalacademy.com
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    •  Periradicular disease associated with a foreign body: overfilled canals, excessive cement in the periodontium, broken instruments proceeding into the apical tissue, and loose retrograde fillings.www.indiandentalacademy.com
    •  Apical perforation : Any perforation that cannot be sealed properly by a filling with in the canal, a one that prevents the proper filling of the anatomic canal & perforation. Incomplete apexogenesis with “blunder buss” a other apices that do not respond to apical closure procedures and all in adequately sealed with an orthograde filling. www.indiandentalacademy.com
    • Persistent & recurringexacerbations during nonsurgical treatment aspersistent, un explainable  Horizontallypain after completion of fractured root tipnon surgical treatment. with Periradicular Treatment of any tooth disease.with a suspicious lesion  Failure to healthat requires a diagnostic following skilled nonbiopsy. surgical endodontic treatment. www.indiandentalacademy.com
    •  Excessively large and intruding periapical lesion: Marsupilization and decompression may be the preferred treatment. Destruction of apical constricture of root canal due to uncontrolled instrumentation that results in an apical foramen that cannot be adequately sealed with an orthograde filling. www.indiandentalacademy.com
    • CONTRAINDICATION: The Contraindication to Periapical surgery are listed in the following sections:General Consideration: Medically compromised a “brittle” patient a patient with an active systemic disease such as uncontrolled diabetes tuberculosis, syphillis, nephritis, blood dyscrasia a osteoradionecrosis. Emotionally distressed patient: a patient unable psychologically to with stand as cope with any surgical procedure. Limitations in the surgical skill and experience of the www.indiandentalacademy.com operator.
    • Local considerations : Localized acute inflammation: where as emergency procedure such as incision and derange or trephination may be indicated, elective periapical surgery should be avoided. Anatomic considerations: procedures that penetrate the mandibular canal, maxillary sinus, mental foramen, floor of the nares, or that serves the grater palatine blood vessels should be avoided when ever possible. www.indiandentalacademy.com
    •  In accessible surgical sites: inaccessible position and location of root apices, especially in posterior teeth, and the need to gain access to the surgical site through dense layers of bone. www.indiandentalacademy.com
    •  Teeth with poor prognosis : short rooted teeth, teeth with advanced periodontal disease, vertically fractured teeth, non-strategic a un-restorable teeth should not be considered for periapical surgery. Finally, periapical surgery should not be considered as a cure – all to compensate for inadequate techniques. www.indiandentalacademy.com
    • Pre operative consultation: A proper preoperative consultation is an essential part of the total surgical experience for both the patient and the clinician. Informed consent: prior to any treatment you must be informed & understand.  What will be done  How it will be done  Why it will be done www.indiandentalacademy.com
    •  What constitutes a successful result.  How likely are your chances of attaining success.  What alternative treatments are available to you.  What risk you may encounter. Generally: Surgical Endodontics is a painless procedure. Treatment is usually accomplished in the dental chair, use in the same kind of anesthesia as for fillings www.indiandentalacademy.com
    • Reactions can occur after treatment such as:  Sore tooth and gum (pain)  swelling, varying from slight to large  black & blue marks  paraesthesia : a numbness or tingling sensation that persists in the treatment area, mainly the low jaw, but usually disappears in time. Routine instruction will be given to patient immediately following surgical instrument treatment, regarding home care, diet & medication. www.indiandentalacademy.com
    •  PREMEDICATION Premedication becomes necessary when a patient remains overly anxious & un affected by the preoperative consultation. The premedication drugs selected should reduce anxiety, enhance the anesthetic to be administered, and favorably reduce salivation, bleeding, a secondary infection (antibiotics). www.indiandentalacademy.com
    •  Short acting barbiturates, such as pento barbital (Nembutal) and seco barbital (seconal ) are frequently used for sedation. Tranquillizes are effective drugs for surgical premedication because they reduce apprehension. Narcotics can be effective premedication but they are given infrequently to the ambulatory patient because of their lasting effect. www.indiandentalacademy.com
    • SURGICAL INSTRUMENTS AND MATERIALS: A surgical set up should consist of al sterile instruments and materials needed to complete the contemplated procedure. A suggested surgical set up for periapical procedures follows: Anesthesia: Aspirating syringe, disposable needle, and several caepules of desired local anesthesia such as lidocaine HCL, 2% epinephrine 1:50,000 Isolation of the operative site: sterile 2 x 2 cotton gauze squares, and cotton pellets or racellets (alcohol sponges or topical antiseptic www.indiandentalacademy.com
    • Incision: Bard – parker handle No 15 blade, andperiodontal probe (to help determine flapdesign).Flap elevation & retraction: Periosteal elevator (unionbroach no: 9)Penetration & removal of cortical bone plate, root resection, andprepration for retrograde filling in the root apex: AssertedS.H (straight hand piece ) bur no 2, 4, 6, 8,33½ , 34, 558, 701, 702 hand chisel ( Hu-friedyNo.1), + sterile saline or anesthetic solution foruse as a coolant and for debridement, hand www.indiandentalacademy.compiece (straight or contra angle) and micro head
    • Curettage : Goldman fox No 3 curette, #surgical excavator ( Hu-friedy no.9 or no.11)Retrograde filling : apical amalgam carrier, plasticinstrument, apical amalgam plugger, andamalgam.Suturing : Needle holder or hemostat, 3-0 or 4-0 silk suture on an atraumatic needle [ atraloc x– 8 needles & 3-0 silk suture, FS-2 needles & 4-0 silk suture ] & scissors.Surgical tray : cotton pliers, explorer mirror, &cotton or racellets. www.indiandentalacademy.com
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    • CLASSIFICATION OF ENDODONTIC SURGICAL PROCEDURES Surgical Drainage:  Incision and drainage  Cortical trephination (fistulative surgery) Periradicular surgery:  Curettage  Biopsy  Root end resection  Root end preparation and filling  Corrective surgery  Perforation repair.  Root resection  Hemisection www.indiandentalacademy.com
    •  Replacement Surgery:  Extraction / Replantation Implant Surgery:  Endodontic implants  Root form Osseo-integrated implants. www.indiandentalacademy.com
    • TYPES OF INCISIONS & FLAPS Horizontal: A simple horizontal incision is often used because of the natural contour of the maxilla & mandible.Semilunar / curved / elliptical flap: It is a curved horizontal incision with convex portion of the incision towards the gingival crest.Indications:  Used when it is desirable to mandible the attached gingiva around the margin www.indiandentalacademy.com
    •  It is important that there should be 2 to 3 mm of distances from the base of the gingival sulcus to the incision.A modified incision that follows the general bone contour is often used to avoid the labial frenum.Advantages: Simple and easy to reflect Once reflected the operator is close to the apex of involved tooth, provides access to apex without impinging on the tissues. www.indiandentalacademy.com
    •  Gingival attachment is not disturbed and marginal gingiva does not receed while healing. . Patient can maintain good oral hygiene.Disadvantages: Restricted access with limited visibility. Chances of tracing the corner of incision while attempting to improve the access. if the incision is over the bony defect it may result in dehiscence and scar formation. flap use is limited by the presence of muscle attachment, canine or other bony prominence. www.indiandentalacademy.com
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    •  Single vertical incision / triangular flap:Indications: Indicated for surgery involving the short rooted teeth (usually single). Incision is made with the root eminences of teeth.Advantages: Provides grater access & visibilities. Affords a view of periodontal defects a bony penetrations. Heals with minimal scar formation. www.indiandentalacademy.com
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    • Disadvantages: Difficult to retract. Vertical & Horizontal incision must be lengthy to gain access. Double vertical incision / Trapezoidal flap: Two oblique incisions are made and entire flap is retracted towards the vestibule.Advantages: Good accessibility. Convenient for teeth with long roots. Convenient for curetting more then one www.indiandentalacademy.com root & large lesions.
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    • Disadvantages: Loss of gingival attachment. Envelope / Gingival flap: used mainly for posterior mandibular and palatal surgery. Grater relaxation of the flap can be achieved giving incisions around the necks of all teeth in a quadrant. A relaxing incision can be added at either end of the flap if the access is still not adequate. www.indiandentalacademy.com
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    • Luebke – Ochsenbein flap / scallopedflap : It is named after Leuebke an endodontist andochsenbein a periodontist who togetherdesigned the flap. www.indiandentalacademy.com
    •  It is a modified semilunar flap in which a scalloped horizontal incision is made in the attached gingiva with accompanying vertical incisions. Scalloped flap is produced by first making a continuous scalloped incision in the firm attached gingiva parallel to the free gingival groove. At both ends vertical oblique relaxation incisions are made. Scalloped incision should be 3-4 mm short of www.indiandentalacademy.com
    • Advantages: Greater access and visibility. Decreases the possibility of placing the incision over the periapical defect. Flap is easily displaced and sutured. marginal gingiva is not disturbed, so there is no gingival recession.Disadvantages: Misjudgment of the size of the lesion resulting in incision crossing the osseous defect. www.indiandentalacademy.com
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    • Trephination www.indiandentalacademy.com
    • TREPHINATIONwww.indiandentalacademy.com
    • Trephination Trephination www.indiandentalacademy.com
    • ROOT END SURGERY www.indiandentalacademy.com
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    • RETROGRADE FILLING A retrograde filling is placed in the apically resorted root when the canal is poorly scaled from the surrounding tissue. The technique used for resection and retrograde filling depends on the accessibility of the root tip in the operative site, the presence of hazardous anatomic structures surrounding the surgical site. The configuration, location and accessibility of the apical foramina to be used. The root is beveled to achieve the access needed to fill all the foramina present on the resected root surface www.indiandentalacademy.com
    • Materials Used: Zinc & Zinc free amalgam – widely used. ZOE cements Cavit Polycorboxylate cement Glass ionomer cement Composite filings Zinc phosphate cement Silver cones Gold foil. www.indiandentalacademy.com
    • Apical seal: The filling at the interface of the canal and periapical tissues should seal the root canal from the surrounding tissue.Technique: The cavity in the bevelled surface of the root is prepared for a retrograde filling with small, round burs followed by inverted cone burs. The ideal preparation has the smallest exposed surface at the apex while www.indiandentalacademy.com encompassing all foramina and extends about
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    • .Technique of root resection : (root amputation) Administration of local anesthesia. Probe the area to determine the extent and outline of alveolar bone destruction among the root to be removed. Elevate the mucoperiosteal flap. With the contraangle hand piece and cross cut bur severe the root where it joins the crown and remove the root. With a stone or diamond point smooth the resected www.indiandentalacademy.com root stumps and contour the tooth.
    • ROOT AMPUTATION www.indiandentalacademy.com
    • HEMISECTION:DEFINITION: Procedure in which one root and itscorresponding crown portion is cut and removed. www.indiandentalacademy.com
    • INDICATIONS: When the periodontal involvement of one root is severe. When loss of bone is extensive in the furcation area. When caries involves much of the roots.Contraindications: Similar to radisectomy.Technique: It involves the same technique as that is used for root resection.The retained mesial and distal halves serves as abutment for In this procedure, half of the crow is removed www.indiandentalacademy.com
    • HEMISECTION:www.indiandentalacademy.com
    • .BICUSPIDIZATION / BISECTION:TECHNIQUE: Molar is cut into two separate mesial and distal portion without the removal of any part of the root or crown. It is performed when the mandibular molar exhibit proper anatomic features and stability. Molar with divergent roots and bone loss restricted to buccal areas all ideal for bicuspidization. The tunnel like effect of the furcation involvement www.indiandentalacademy.com creating two is eliminated by
    • BICUSPIDIZATION /BISECTION: www.indiandentalacademy.com
    • Complications of Endodontic Surgery:1) Swelling2) Pain3) Echymosis4) Paraesthesia5) Stitch abscess6) Hemorrhage7) Perforation8) Iatrogenic damage to adjacent teeth.9) Incision failure. www.indiandentalacademy.com
    • a n kT h Y o u www.indiandentalacademy.com